ATTITUDES/BELIEFS AND CULTURE

Owoeye Olugbenga A.
MBChB, MSc, FMCPsych

Federal Neuro-Psychiatric Hospital, Yaba Lagos

Outlines
Introduction
Attitude/Beliefs-- Components, Features. Theories Measurement Culture

Culture and Health Culture and Mental health Conclusion

Introduction
Social Psychology Human behaviour is always influenced by the social context in which it occurs. Mans life is inescapably social.
Man is bound to interact with other individuals and groups.

 Social psychology is the scientific study of how individuals behave, think and feel in a social situation. That is, how others influence one another, whether in the actual, or implied or imagined presence of others (Baron & Byrne 1990, Coon 1995). SP focuses on the situational causes of behaviour (as opposed to developmental or personality factors), and on the individuals subjective view of the situation.

Attitude
The concept of attitude has been regarded as central and fundamental to social psychology. The reason being that attitude plays a vital role in determining our social behaviour..

 Consequently, this makes attitude so important to our understanding of peoples sterotypes, prejudices, voting intention, consumer behaviour and interpersonal attraction, to mention but a few of the major areas in social psychology.

What is attitude?
A construct that has no universally accepted definition because it cannot be observed directly, but can be inferred from measurable response, that is, behaviour.

Coon (1995) defined an attitude as a mixture of beliefs and emotion that predisposes a person to respond to other people , objects,or institution in a positive or negative way.

 Newcomb (1961) defined attitude as a learned predisposition to respond in a consistently favourable or unfavourable manner with respect to a given object. Further attempts, to define attitude have led to structural analysis of the component of attitude. Katz (1960) propounded three components of attitude as (i) Cognitive component, (i) Affective component, and (iii) Connative component.

Cognitive component
It refers to the thoughts, beliefs and ideas about attitudes to objects. This includes the way we think about people, situations, institutions and events. For example, suppose I think that people from Yoruba land (an ethnic group in Nigeria) are wicked and hostile. This is an example of cognitive component of attitude.

Affective component
Refers to the emotion and feelings about attitude to objects, events, situations and people that enable one to evaluate them as good or bad. For example, a policeman brutally dealing with an innocent citizen may create feeling of hatred in us (attitude) towards all policemen generally.

Connative component
Refers to the predisposition to behave or act in a particular way towards an object or person. This could be as a result of the two other component of cognitive and affection.
For example, the thought and feeling one holds towards an object or people predetemined how he will act either positively or negatively.

 Myer (1993) in agreement with this component theory of attitude gave the ABC of attitude as: A. Affective component B. Behavioural component C. Cognitive component.
Thus, attitude can be defined as the acquired belief and feeling, which determine the positive or negative response towards people, object, events and situations.

Features of attitudes
Attitudes have the following features 1. Attitudes are formed and acquired through socialisation and they are not innate or inherited from parents. 2. Attitudes are inferred from abservable behaviour, which are consistent over time. 3. Attitudes are inferred from verbal or non-verbal behaviour.

4. Attitudes is the frame of reference by which an individual evaluates social stimuli (objects or person). 5. An attitude could be a favourable (positive) or unfavourable (negative) mental set. 6. Attitudes are measurable. 7. An attitude has 3 components cognitive, affective and connative 8. Attitudes can be changed over time.

Attitude formation
Attitudes are formed through socialisation, and this could take palce in different situations ranging from family, schools, peer group, community to the mass media. Coon (1995) examined basic ways of acquiring attitudes as the following:

i. Direct contact with object of attitude

Attitudes are formed basically from the experience an individual had when in direct contact, with people concerned. This may be in form of the impression one had about a phenomenon. For example, an individual treated badly by the attendant of restaurant, could form a negative attitude to that particular restaurant based on hisexperience.

ii. Interaction with others

Attitudes can be formed based on information obtained from friends, neighbours and members of the society.
Such information influences our thoughts and feelings thereby influencing our responses favourably or unfavourably.

iii. Child rearing style

The effect of parental values,beliefs and practices has a vital influence on the childs attitude formation towards objects or people. The child tends to inculcate the parental values and beliefs as his/her frame of reference. Parental ve attitude towards traditional festival may lead to children that will have the same negative attitude towards traditional festivals as a result of parental imitation and upbringing.

iv. Group membership

Social influences associated with belonging to various groups have impact on attitude formation. There are many beliefs and thoughts we hold as a result of conformity to the group. Every group has rules and regulations to which each member must conform or face sanctions. These rules and regulation also shape the members attitude either favourably or unfavourably toward a phenomenon.

For example, a grassroots political party will expect its members to have positive attitudes towards the masses and towards meeting their needs. Also, members of one ethnic group may have negative attitude towards suitor from another ehtnic group seeking to marry their daughters.

v. Mass media
Television, radio, newspapers and magazines have influence on attitude formation. The message we receive from such media affect our thoughts and belief formation as well as our response to the attitude object. The advertisement and publicity on the Media are aimed at either forming or changing the attitude toward object or people.

Attitude measurement
Several techniques of measurement or scaling have been developed in order to rank individuals with respect to attitudes.
Attitude scales have emerged as the most objective technique measuring the strength of attitudes. Attitude scales consist of statements expressing various possible views of an individual on an issue: stigma, religion, etc.

 Thurstone (1928) constructed his attitude scales by assembling a large number of statement concerning a topic of interest on the scale of mildly favourable, mildly unfavourable and strongly unfavourable.

Hence judgment was made as to the degree to which an individual indicated favourable or unfavourable to a given statement.

 Likerts (1932) attitude scale was constructed to eliminate some of the pitfalls of Thurstones attitude scales. Likerts attitude scale was a 5-point scale of strongly agree, agree, undecided, disagree and strongly disagree. By computing the score on all items, a person can be rated for overall acceptance or rejection of a particular issue. When used in opinion polls attitude scales have provided useful information about the attitude of the people measured.

Theories of attitude
Several theories have emphasised different factors responsible for attitude formation and attitude change.
These include learning theory, balance theory, cognitive dissonance theory, selfpresentation theory, expectancyvalue theory, and cognitive response theory.

Learning Theory The learning theory of attitude holds the assumption that attitude is formed and changed in the same way we form and change habits.
People learn to love or hate, based on fact and information they get on a daily basis about different attitude objects.

 In addition to association process of attitude formation, reinforcement and punishment function in acquisition of attitude and attitude change. Thus, the consequences of behaviour determine if such behaviour will occur again.

Furthermore, attitude can also be formed or changed as a function of imitation. Children tend to imitate thier parents beliefs and actions while the adolescents imitate the beliefs and actions of their peer groups on many issues, thereby forming or changing their own attitude.

Balance theory
Balance theory propounded by Fritz Heider (1958) assumes that the individual strives for balance in his cognition. Any incongruence in the individuals belief and behaviour leads to imbalance in cognition, which produces tension. However, to reduce the tension, the individual strives for a balance, either by accepting, the new behaviour and change in attitude, or complete rejection of the new behaviour and maintain the attitude.

Self-presentation theory
Self-presentation theory explains how our need to be consistent with social expectations affects our attitude. The need to create the right impression of ourselves to the people make us adjust our social performance to meet the desired outcome.

Cognitive dissonance theory

Festingers (1975) cognitive dissonance theory holds the asssumption that tension arises within an individual when there is a disagreement in ones thoughts and beliefs. To reduce this tension, the individual must adjust his/her attitude, either by rejecting the conflicting thought or rationalising it and absorbing the new thought into ones attitude.

Expectancy value theory

Expectancy value theory assumes that people form or change attitude based on the expected outcome of their position, i.e. The cost or benefit associated with a particular attitude position. Thus, the value of a particular attitude and the expectancy that this position will produce that outcome determine ones attitude.

 For example, Mr Jimoh had to decide either to go to the library or go to the pool house, his decision will be based on the possible expectation (outcome) of each action (as in read book, acquire knowledge or relax and gamble) as well as the value of the outcomes (pass the exams and get promotion or fail exams and take risk in gambling).

 Thus, weighing the expected outcome and the value of ones action (what you gain or lose) determine the individuals attitude formation or attitude change toward an attitude object.

Cognitive response theory

Cognitive response theories seek to understand how peoples cognitive response to persuasive communication aid their attitude formation and attitude change. Every persuasive communication is received with either positive or negative responses, depending on the individuals position on the subject matter.

 This positive or negative response determine ones attitude. That is, the interpretation and meaning given to every message received determines the individuals attitude position. The cognitive response theorists assume that people are active processors of information received from difficult messages. Their interpretation of the information either forms a new attitude or changes the existing attitude or fits into the existing attitude.

 In summary, all the theories of attitude and attitude change show that theories is all encompassing, free from challenges and shortcomings. The way forward is for all the theories to be seen as complementary to one another, rather than competing with each other, as a way of understanding attitude and attitude change.

Culture
Culture is defined as a set of guidelines, which people inherit as members of a particular society. It includes knowledge, belief, art, morals, customs and any other capabilities and habits acquired by the person as a member of the society. It comprises systems of shared ideas, systems of concepts and rules, and meanings that underlie and expressed in the ways that human beings live. Culture is dynamic.

 Cultural background has an important influence in many aspects of peoples lives including their beliefs, behaviours, perceptions, emotions, language, religion, rituals, family structure, diet, dress, body image, and attitude towards illness, pain and other forms of misfortune. It should be noted, however, that the ff may have an influence on an dividual; other factor include age, gender, appearance, personality, intelligence, experience, education both formal and informal.

 Socio-economic factors such as social class, economic status, occupation and the network of social support from other people are also factors influencing the health status of individuals. Political factors also influence peoples behaviour. People may have high levels of anxiety in thier daily lives not because their culture makes them anxious, but because they are suffering discrimination or persecutions from other people.

Cultural relativism
Relativism is the view that cultures are varied and may not be comparable as they are unique in their own right.

According to this view, cultures have to be appreciated and understood in their contexts. Beliefs or practices that seem to be normal may be considered strange in another culture.

 So, cultural relativism is the view that no culture is superior to another and that beliefs, values , behaviours and practices of all cultures are rational and should not be judged on the standards of other cultures.

Ethnocentrism
Ethnocentrism is the view that ones own culture is superior to all other cultures. In ethnocentrism, other peoples cultures are evaluated with reference to ones own cultural assumptions, values and customs. Other peoples beliefs and practices are seen as inferior or wrong.

Health and illness

The culture of a society constructs the way its members think, perceive and feel about sickness and healings. Health problems should be viewed as cultural phenomena; they are associated with the persons conditions of existence, commmunicated in culturally prescribed ways, labelled in accordance with cultural concepts, and experienced in a manner that is influenced by prevailing cultural ideas.

 Health problems are communicated to others in ways that are culturally prescribed. A sick person in one culture may be expected to show pain, while in another culture suffering in silence is prized. In some cultures, people afflicted with disease are secluded, while in other cultures they are expected to be in company of others.

The cultural communication of health problems

The cultural experience of health problem

The manner in which people experience health problem is influenced by prevailing cultural ideas. An illness may be regarded as fatal in one culture while the same illness is regarded a harmless in another culture.

 Such perceptions may affect peoples help-seeking behaviour, as well as their responses to and experience of that illness. Among the Basoga of Eastern Uganda, it is believed that hydrocele (empanama omushuha), affecting men, is a sign of wealth and not disease.

The relationship between culture and health

People socialised to take on certain roles and responsibilities in society. Some of these roles are detrimental to health. The roles people play may motivate behaviours that place them at risk.

 Four common risk factors are discussed: the expectation that men should be bread-winner, the distinction between masculine and feminine behaviours and emotions, violence associated with bride price, and the value placed on the virginity of unmarried girls. Effects of culture on the clinical presentation of symptoms are briefly discussed.

Culture and Health

Mental illness and disease: the role of ancestors. In African traditions, ancestors play an important role in the conceptualisation of the causes of mental illness and disease. Since time immemorial, ancestor-alive-or dead-have always had power to bless or curse. In the event of a curse, the one cursed may suffer from a serious mental disorder.

 One becomes sad, unhappy and mentally deranged. The curse can affect ones physical body or property. The diagnosis and treatment of the curse are considered beyond western medicine.

Contributions from cultural psychology

Cultural psychology is the study of the way cultural traditions and social practices regulate, express and transform the human psyche, resulting less in psychic unity for humankind than in ethnic divergences in mind, self and emotion.

 Cultural psychology also postulates that subject and object, self and other, psyche and culture, person and context, figure and ground, and practitioner and practice, live together, require each other, and dynamically, dialectcally, and jointly make each other up. It recognises the dynamic interdependence between human action and culture.

The relationship between culture and mental health

There are two major competing paradigms concerning the relationship between culture and mental disorder: universalism and relativism. Universalism, the dominant model of mental illlness in the biomedical sciences, assumes that underlying psychological process are the same across all cultural groups.

 This is known as psychic unity. Culture is thought to mask basic underlying pscyhological universals. The view that culture only modifies the expression of psychological distress is consistent with universalism. Culture is thought to exercise an exterior action it affect only the symptomatic form that psychiatric disorders take in different cultures.

 The clinicians role under these circumstances is to strip off the layers of culture to uncover the basic underlying bases of human distress. Diagnostic categories are thought to be equivalent. The universality of conceptual and diagnostic categories developed in the west has been questioned. Universalists are victims of category fallacy, which is the tendency to impose their own conceptual categories on deviant behaviours observed in other cultures.

 The universal applicability of westernderived assessment insruments has also been questioned. From a relativistic perspective, culture plays a fundamental role in psychopathology: it is impossible to speak of mental illness behaviour without taking cognisance ofthe cultural context in which is manifest. Culture is not just exogenous force that exerts an influence on behaviour; mental illness and culture are mutually embedded.

 The relativitic position has been brought to the fore. Universalism ignores peoples real life suffering, concentrating only on a limited range of symptoms. It tends to focus on the disease, rather than illness. The feelings of hopelessness associated with depression in western culture constitute a desired state of affairs for Buddhist monks, who see hopelessness as a vehicle to achieve salvation

 The solution to the problem of culture does not reside in either universalism or relativism. Radical relativism makes crosscultural comparisons impossible, thus ruling out any possibility of developing a unified theory of knowledge.
Others have argued that a unified of knowledge could be developed from the bottom up by conducting studies in different cultures.

 Another potential problem with relativitism is that there is a danger of stripping culture of its ideological and political character, especially if it is only conceptualised psychologically, in terms of values and beliefs.

Culture and diagnosis

Cultural factors are increasingly recognised in mental health literature. In 1993 the American Psychological Association published guidelines highlighting how to frame assessment and interventions with respect to the patients culture, including religion and indigenous practices, the patients support systems and psycho-social stressor.

 The DSM-IV acknowledge s the importance of locating assessment and diagnosis in relation to the patients culture. The introduction to the DSM-IV notes that. Special efforts have been made in the preparation of DSM-IV to incorporate

an awareness that the manual is used in culturally diverse populations in the United States of American and internationally.

 The DSM-IV includes a framework fortaking culture into consideration in psychiatric and psychological formation. However, it assumes that culture only influences symptoms of depression; the underlying disorder is presumed to be universal.

 Further, the culture-bound syndromes described are limited to culturally different groups. The term culturebound syndromes refers to localised or culture-specific disorders. Culture bound disorders present with a cluster of symptoms or behavioural changes that are recognised by locals and responded to in a particular manner.

 Folk diagnostic categories have been developed to refer to these localised troubling sets of experiences. An example is amafufunyane a form of spirit possession which the Nguni of South African attitude to sorcery. Critics note that disorders such as anorexia nervosa and chronic fatigue syndrome could be regareded as western culture-bound syndromes, attributable to the meanings assigned to the (female) body and work in western culture.

 However, these were not included in the DSM-IV list ofculture-bound syndromes, thus reinforcing the view that culture only pertains to minority groups or people in distant places. Culture plays a central role in diagnosis. It suffises all aspects of the diagnostic process and the first task for the clinician is to determine whether the presenting sypmtoms can be explained by the patients cultural patterns.

 For example, hearing voices is not uncommon among some religious groups. Among the Nguni in South Africa, there is a condition known as unkwasa, an ancestral calling (usually involuntary) to become a traditional healer.

CULTURE AND AETIOLOGY

Problems and misfortune may be seen in a group, rather than individual terms. Among the Shona of Zimbabwe, relatives actions may affect the whole family, for instance in cases of murder. Solutions must therefore involve clans.

 Moreover, whereas in western understandings the consultation process involves a physically present patient, in some African settings, the patient could be absent, with treatment sometimes taking place miles away from where the patient lives

Social and cultural determinants of Health seeking behaviour

Health seeking behaviour usually depends on the type and severity of symptoms, the cause of the illness and the labels and aetiologies attached to it. Other factors include socio-economic status, age, sex, educational level, occupation, residence (urban ot rural)and family role.

 Social and cultural determinants of health seeking behaviour are charateristics of condition, the patient, the healer and service.

Culture and health: the benefits and pitfalls

Understanding cultural and social factors influencing health is important for the medical practitioner as it provides a more complete view of health problems.

 It is therefore important that workers initiate culturally informed inquries, so that interventions may become relevant to the content of the problem, its context, and the underlying structure of beliefs and expectations.